Implementation of noninvasive liver disease screening tools in primary care

The global increase in the incidence of metabolic dysfunction-associated steatotic liver disease (MASLD), which affects more than one-third of the general population and up to 70% of individuals with type 2 diabetes or obesity, is a critical public health challenge. Given that liver steatosis is often asymptomatic until the advanced stages of disease, early detection is essential to prevent its progression to fibrosis, cirrhosis and, ultimately, hepatocellular carcinoma. However, liver biopsy, the gold-standard diagnostic method, is invasive, costly, and unsuitable for large-scale screening. As a result, noninvasive tests have emerged as practical alternatives, particularly in primary care settings, where early identification is most feasible. The present study explored current perspectives of noninvasive liver disease screening tools and their implementation in primary care. Serum-based indices, along with imaging techniques, have demonstrated promise in identifying patients with advanced fibrosis. Novel biomarkers, including the enhanced liver fibrosis test and Pro-C3, as well as emerging artificial intelligence-assisted diagnostic platforms, yield improved accuracy and risk stratification potential. Despite accumulating evidence supporting the clinical utility and cost-effectiveness of noninvasive tests, several barriers hinder their routine use in primary care settings, which include limited funding, lack of standardized guidelines, insufficient clinician training, and disparities in access to diagnostic tools. The implementation of structured stepwise screening models has demonstrated improved diagnostic efficiency and reduced unnecessary referrals. Future research should emphasize the integration of artificial intelligence, portable diagnostic devices, and personalized risk models to enhance early detection. Ensuring widespread adoption requires coordinated efforts in policy development, provider education, and health-system investment. Noninvasive screening tools offer a feasible and cost-effective pathway for the early detection of MASLD in primary care; however, their successful implementation depends on addressing logistical, educational, and systemic barriers.